Alexandra Pais/For The Star-LedgerA vaccine is given during the the Maplewood Township flu clinic for township employees and public health workers at the Town Hall on Jan.11, 2010.

For more than a decade scientists, doctors, parents and public advocacy groups have fiercely debated whether a childhood immunization called MMR can cause autism.

It all started with the 1998 publication of an article linking the two in the British journal The Lancet, although it wasn’t so much the research — the study involved just 12 children — as the lead author’s conviction, which caused the world-wide stir.

At the time, Andrew Wakefield, a gastroenterologist at a London hospital, told journalists his withdrawal of support for the three-in-one vaccine for measles, mumps and rubella (MMR) wasn’t just medical; it was "moral."

In the aftermath, parents around the world, fearing the specter of autism, decided against vaccinating their children.

Eleven months ago — and 12 years after its publication — Wakefield’s autism-vaccination study was retracted by the medical journal in which it first appeared, The Lancet, because it found Wakefield had engaged in a "biased selection of patients." Ten of the 13 co-authors removed their names from the study, and the General Medical Council, which regulates doctors throughout the United Kingdom, said Wakefield had exhibited a "callous disregard for the distress and pain of children."

This week the British Medical Journal revealed new evidence that Wakefield and his colleagues deliberately altered some of the patient medical data in the original study. The information was so striking that Fionee Godlee, the journal’s editor, called Wakefield’s research "an elaborate fraud."

Outrage and sadness reverberated across the globe.

"Putting children at risk on false evidence is criminal," said Peter Wegner, medical director of Newark’s Project Vaccinate and an associate professor at the School of Public Health at the University of Medicine and Dentistry New Jersey.

Jane Sarwin, director of Public Health Initiatives at Gateway NW Maternal & Child Health Network in Newark, was more blunt:

"Children died for no reason because of this," she said.

The impact of more than a decade of debate over the possible link between vaccination and autism, say doctors and researchers in New Jersey, has been especially profound in the Garden State, which has the highest rate of the autism in the country at 1 in 94 (compared to the national average of 1 in 110).

"The dishonesty in presenting supposedly scientific evidence has done tremendous harm," said Wenger, who cited the millions of dollars of research money that has been misspent and the rise of childhood infectious diseases as parents decided to forego, or at least delay, vaccinating their children.

States vary on the regulation of individual vaccines. In New Jersey, MMR is mandated for all children in daycare and those attending public or private schools, although several public advocacy groups have lobbied for the inclusion of a conscientious objection amendment to the law.

Doctors consider measles the most dangerous of the three childhood illnesses that the MMR vaccine protects against, as it can cause pneumonia, swelling of the brain and even death. A single vaccine against measles, developed in the 1960s, had virtually eliminated the infectious disease in most developed countries — until Wakefield’s study.

"There is no question the rate of immunization in England dropped dramatically," said Meg Fisher, medical director of Children’s Hospital at Monmouth Medical Center, and the consequence here has been "imported measles from the U.K. and other areas of Europe."

In 2007, 127 U.S. residents — 99 of them unvaccinated — were infected with measles according to the CDC, the highest number since 1996. Outbreaks in recent years have been reported in California, Illinois, New York and Wisconsin.

"What we’ve seen in this country is more spread of the disease because of pockets of non-immunized children," said Fisher, "and that’s because of the choice of parents, not lack of vaccine or the socio-economic status of families."

In the first three years of the last decade there were no reported cases of measles or mumps in New Jersey. Between 2003 and 2009, however, 11 cases of measles and 248 of mumps were reported to the New Jersey Department of Health and Senior Services.

Historically, New Jersey’s rate of MMR immunization has been higher than the national average, but according to the CDC in 7 of the last 10 years, including the last five, the state’s rate of childhood MMR vaccination has fallen below the national average.

In 2009, the most recent year statistics were available, only five states had marginally lower rates of MMR immunization than New Jersey.

"The saddest part about the whole thing is that (Wakefield’s) research led so many people to a belief that something else was responsible for autism," Fisher said. "The good news is children are made pretty well and can withstand a lot. It’s just that it’s horrible to lose even one child to a vaccine-preventable disease."